Mirco Schapher

Nearly 3,000 salivary stones: Some clinical and epidemiologic aspects

To investigate epidemiological features and symptoms of sialolithiasis and their implications for diagnosis and management.

Salivary Leptin as a Candidate Diagnostic Marker in Salivary Gland Tumors

BACKGROUND Since the discovery of autonomous leptin production in salivary glands, very few studies have reported on the physiological or pathological meaning of this particular cytokine in saliva. The aim of this study was to investigate the expression of leptin and its receptors Ob-Ra and Ob-Rb in parotid salivary gland tumors, with particular regard to a potential use of leptin as a tumor marker. METHODS Parotid tissue samples from healthy individuals (n = 31) and tumor patients (n = 97, including tissue samples from pleomorphic adenomas, adenolymphomas, basal cell adenomas, and diverse carcinomas) were analyzed by use of ApoTome-technique microscopy, immunohistochemistry, immunofluorescence, immunoblotting, and quantitative real-time PCR. Salivary and plasma leptin concentrations were measured by using ELISA. Ultrasound was used to determine tumor size before surgery. RESULTS In all salivary gland tumors leptin was expressed in much higher amounts than in healthy parotid tissues. The cytokine was not imported from the blood but actively produced by the tumors. Immunoblotting results indicated that leptin was present as oligomers in salivary glands. Furthermore, the examined tumors overexpressed the receptor isoforms Ob-Ra and Ob-Rb. Measured leptin concentrations in mixed saliva samples were significantly increased in patients with parotid tumors [mean (SD) 673 (484) pg/mL in pleomorphic adenomas, 679 (465) pg/mL in adenolymphomas, and 880 (618) pg/mL in carcinomas] vs controls [125 (36) pg/mL] (P < 0.001). CONCLUSIONS This is the first study to show that the analysis of salivary leptin in mixed saliva samples may allow preoperative differentiation between tumor patients and healthy individuals.

Salivary cytokines in cell proliferation and cancer.

While the presence of multiple systemic steroids, amines and peptides in saliva has been reported, other hormones of the circulation do not appear in saliva. Substances present within saliva may be classified in different groups: first, those which passively display blood plasma concentrations and constitute a promising alternative to evaluate certain systemic parameters. Second, molecules which seem to play a more active, regulatory role within the upper gastrointestinal tract. Concerning the latter, a growing awareness, especially with regards to salivary peptides has been established. Up to now, understanding the distinct effects of salivary peptides known so far is in its infancy. Various publications, however, emphasize important effects of their presence. Salivary peptides can influence inflammatory processes and cell proliferation in epithelia of the upper digestive tract. These include transforming growth factors (TGFs), epidermal growth factors (EGFs), vascular endothelial growth factors (VEGFs) as well as amines such as melatonin. Of those, candidate cytokines like interleukin 8, tumor necrosis factors (TNFs) and leptin are involved in neoplastic activities of salivary glands and the oral cavity. The exact mechanisms of action are not yet completely understood, but their presence can be utilized for diagnostic purposes. Salivary gland tumors in patients may, in certain circumstances, be identified by saliva diagnostics. Saliva samples of the concerned patients, for instance, reveal significantly higher leptin concentrations than those of healthy individuals. Numerous studies postulate that, beside single indicators, the establishment of salivary hormone profiles may assist clinicians and researchers in detecting tumors and other pathologies of the oral cavity, including adjacent tissues, with high sensitivity and specificity.

Intraductal pneumatic lithotripsy for salivary stones with the StoneBreaker: Preliminary experience

To test the effectiveness of a newly approved pneumatic lithotripter for fragmentation of salivary stones.

Der Stellenwert der extrakorporalen Stoßwellenlithotripsie bei der Therapie der Sialolithiasis

INTRODUCTION Extracorporeal shock wave lithotripsy (ESWL) is now judged alongside other therapeutic alternatives like salivary gland endoscopy (SGE). The present analysis investigates the significance of ESWL within the scope of a defined treatment algorithm. METHODS A retrospective analysis of data obtained between 2003 and 2009. The results were analysed according to the therapeutic modality used. Successful treatment was defined as an absence of symptoms or stones at follow-up examination. RESULTS During the period studied, 206 patients with parotid stones and 736 with submandibular stones underwent treatment. Among the latter group, 5 % were treated exclusively by SGE, 92 % underwent transoral stone removal and 3 % received ESWL. The long-term success rates were 93 %, 90 % and 94 %, respectively. Patients with parotid stones were treated in 78 % of cases by ESWL and 22 % underwent SGE exclusively. The overall long-term success rates here were 85 % and 98 %, respectively. CONCLUSION ESWL remains an important therapeutic tool in the management of sialolithiasis. The method is particularly important as a gland-preserving tool in the therapy of parotid stones and selected cases of submandibular stones, even though it is not available in the US due to the lack of official equipment approval.

The significance of extracorporeal shock wave lithotripsy in sialolithiasis therapy

INTRODUCTION Extracorporeal shock wave lithotripsy (ESWL) is now judged alongside other therapeutic alternatives like salivary gland endoscopy (SGE). The present analysis investigates the significance of ESWL within the scope of a defined treatment algorithm. METHODS A retrospective analysis of data obtained between 2003 and 2009. The results were analysed according to the therapeutic modality used. Successful treatment was defined as an absence of symptoms or stones at follow-up examination. RESULTS During the period studied, 206 patients with parotid stones and 736 with submandibular stones underwent treatment. Among the latter group, 5 % were treated exclusively by SGE, 92 % underwent transoral stone removal and 3 % received ESWL. The long-term success rates were 93 %, 90 % and 94 %, respectively. Patients with parotid stones were treated in 78 % of cases by ESWL and 22 % underwent SGE exclusively. The overall long-term success rates here were 85 % and 98 %, respectively. CONCLUSION ESWL remains an important therapeutic tool in the management of sialolithiasis. The method is particularly important as a gland-preserving tool in the therapy of parotid stones and selected cases of submandibular stones, even though it is not available in the US due to the lack of official equipment approval.

Value of Sonography in the Diagnosis of Sialolithiasis: Comparison With the Reference Standard of Direct Stone Identification: Sonography in the Diagnosis of Sialolithiasis

The aim of this study was to assess the effectiveness of sonography for diagnosing sialolithiasis in comparison with the existing reference standard of direct identification of a stone.

Transoral submandibulotomy for deep hilar submandibular gland sialolithiasis

To assess the long‐term results after transoral submandibulotomy for stones located in the deep hilar and intraparenchymal submandibular region.

Multimodal treatment in difficult sialolithiasis: Role of extracorporeal shock-wave lithotripsy and intraductal pneumatic lithotripsy: ESWL and IPL in Difficult Sialolithiasis

To assess results after treatment of difficult/complex sialolithiasis with extracorporeal shock‐wave lithotripsy (ESWL) and intraductal pneumatic lithotripsy (IPL).

Long-term oncologic and functional outcome in pleomorphic adenomas of the submandibular gland

The aim of the study was to evaluate the oncologic and functional long‐term outcome after surgical therapy of pleomorphic adenomas of the submandibular gland.